A 35-year-old patient with multiple sclerosis has a new brain MRI. Which MRI pulse sequence is MOST sensitive for detecting cortical and juxtacortical demyelinating plaques?

• A T1-weighted post-gadolinium
• B T2-weighted FLAIR (Fluid-Attenuated Inversion Recovery) ✓
• C T2*-weighted gradient echo
• D Proton density without fat saturation

Explanation

FLAIR suppresses CSF signal (which is bright on standard T2), making periventricular and juxtacortical plaques much more conspicuous against the now-dark CSF background. Plaques that would be obscured by adjacent bright CSF on T2 are clearly visible on FLAIR. T1-post gadolinium detects active/enhancing plaques. T2* (GRE) is sensitive for haemosiderin and veins. FLAIR is the standard sequence for MS plaque burden assessment.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.